Cortical responsiveness during inner speech in schizophrenia: an event-related potential study

Hallucination Proneness Alters Sensory Feedback Processing in Self-voice Production

BACKGROUND

Sensory suppression occurs when hearing one's self-generated voice, as opposed to passively listening to one's own voice. Quality changes in sensory feedback to the self-generated voice can increase attentional control. These changes affect the self-other voice distinction and might lead to hearing voices in the absence of an external source (ie, auditory verbal hallucinations). However, it is unclear how changes in sensory feedback processing and attention allocation interact and how this interaction might relate to hallucination proneness (HP).

STUDY DESIGN

Participants varying in HP self-generated (via a button-press) and passively listened to their voice that varied in emotional quality and certainty of recognition-100% neutral, 60%-40% neutral-angry, 50%-50% neutral-angry, 40%-60% neutral-angry, 100% angry, during electroencephalography (EEG) recordings.

STUDY RESULTS

The N1 auditory evoked potential was more suppressed for self-generated than externally generated voices. Increased HP was associated with (1) an increased N1 response to the self- compared with externally generated voices, (2) a reduced N1 response for angry compared with neutral voices, and (3) a reduced N2 response to unexpected voice quality in sensory feedback (60%-40% neutral-angry) compared with neutral voices.

CONCLUSIONS

The current study highlights an association between increased HP and systematic changes in the emotional quality and certainty in sensory feedback processing (N1) and attentional control (N2) in self-voice production in a nonclinical population. Considering that voice hearers also display these changes, these findings support the continuum hypothesis.

Stronger tilt aftereffects in individuals diagnosed with schizophrenia spectrum disorders but not bipolar disorder

An altered use of context and experience to interpret incoming information has been posited to explain schizophrenia symptoms. The visual system can serve as a model system for examining how context and experience guide perception and the neural mechanisms underlying putative alterations. The influence of prior experience on current perception is evident in visual aftereffects, the perception of the "opposite" of a previously viewed stimulus. Aftereffects are associated with neural adaptation and concomitant change in strength of lateral inhibitory connections in visually responsive neurons. In a previous study, we observed stronger aftereffects related to orientation (tilt aftereffects) but not luminance (negative afterimages) in individuals diagnosed with schizophrenia, which we interpreted as potentially suggesting altered cortical (but not subcortical) adaptability and local changes in excitatory-inhibitory interactions. Here, we tested whether stronger tilt aftereffects were specific to individuals with schizophrenia or extended to individuals with bipolar disorder. We measured tilt aftereffects and negative afterimages in 32 individuals with bipolar disorder, and compared aftereffect strength to a previously reported group of 36 individuals with schizophrenia and 22 healthy controls. We observed stronger tilt aftereffects, but not negative afterimages, in individuals with schizophrenia as compared to both controls and individuals with bipolar disorder, who did not differ from each other. These results mitigate concerns that stronger tilt aftereffects in schizophrenia are a consequence of medication or of the psychosocial consequences of a severe mental illness.

Correlation of motor-auditory cross-modal and auditory unimodal N1 and mismatch responses of schizophrenic patients and normal subjects: an MEG study

Introduction

It has been suggested that the positive symptoms of schizophrenic patients (hallucinations, delusions, and passivity experience) are caused by dysfunction of their internal and external sensory prediction errors. This is often discussed as related to dysfunction of the forward model that executes self-monitoring. Several reports have suggested that dysfunction of the forward model in schizophrenia causes misattributions of self-generated thoughts and actions to external sources. There is some evidence that the forward model can be measured using the electroencephalography (EEG) and magnetoencephalography (MEG) components such as N1 (m) and mismatch negativity (MMN) (m). The objective in this MEG study is to investigate differences in the N1m and MMNm-like activity generated in motor-auditory cross-modal tasks in normal control (NC) subjects and schizophrenic (SC) patients, and compared that activity with N1m and MMNm in the auditory unimodal task.

Methods

The N1m and MMNm/MMNm-like activity were recorded in 15 SC patients and 12 matched NC subjects. The N1m-attenuation effects and peak amplitude of MMNm/MMNm-like activity of the NC and SC groups were compared. Additionally, correlations between MEG measures (N1m suppression rate, MMNm, and MMNm-like activity) and clinical variables (Positive and Negative Syndrome Scale (PANSS) scores and antipsychotic drug (APD) dosages) in SC patients were investigated.

Results

It was found that (i) there was no significant difference in N1m-attenuation for the NC and SC groups, and that (ii) MMNm in the unimodal task in the SC group was significantly smaller than that in the NC group. Further, the MMNm-like activity in the cross-modal task was smaller than that of the MMNm in the unimodal task in the NC group, but there was no significant difference in the SC group. The PANSS positive symptoms and general psychopathology score were moderately negatively correlated with the amplitudes of the MMNm-like activity, and the APD dosage was moderately negatively correlated with the N1m suppression rate. However, none of these correlations reached statistical significance.

Discussion

The findings suggest that schizophrenic patients perform altered predictive processes differently from healthy subjects in latencies reflecting MMNm, depending on whether they are under forward model generation or not. This may support the hypothesis that schizophrenic patients tend to misattribute their inner experience to external agents, thus leading to the characteristic schizophrenia symptoms.

The moderating effect of cognitive impairment on the relationship between inner speech and auditory verbal hallucinations among chronic patients with schizophrenia

BACKGROUND

Even though there is an increasing amount of evidence from behavioral and neuroimaging studies to suggest that pathological inner speech plays a role in the emergence of auditory verbal hallucinations (AVH), studies investigating the mechanisms underlying this relationship are rather scarce. Examining moderators might inform the development of new treatment options for AVH. We sought to extend the existing knowledge by testing the moderating role of cognitive impairment in the association between inner speech and hallucinations in a sample of Lebanese patients with schizophrenia.

METHODS

A cross-sectional study was conducted from May till August 2022, enrolling 189 chronic patients.

RESULTS

Moderation analysis revealed that, after controlling for delusions, the interaction of experiencing voices of other people in inner speech by cognitive performance was significantly associated with AVH. In people having low (Beta = 0.69; t = 5.048; p < .001) and moderate (Beta = 0.45; t = 4.096; p < .001) cognitive performance, the presence of voices of other people in inner speech was significantly associated with more hallucinations. This association was not significant in patients with high cognitive function (Beta = 0.21; t = 1.417; p = .158).

CONCLUSION

This preliminarily study suggests that interventions aiming at improving cognitive performance may also have a beneficial effect in reducing hallucinations in schizophrenia.

A Narrative Review of Speech and EEG Features for Schizophrenia Detection: Progress and Challenges

Schizophrenia is a mental illness that affects an estimated 21 million people worldwide. The literature establishes that electroencephalography (EEG) is a well-implemented means of studying and diagnosing mental disorders. However, it is known that speech and language provide unique and essential information about human thought. Semantic and emotional content, semantic coherence, syntactic structure, and complexity can thus be combined in a machine learning process to detect schizophrenia. Several studies show that early identification is crucial to prevent the onset of illness or mitigate possible complications. Therefore, it is necessary to identify disease-specific biomarkers for an early diagnosis support system. This work contributes to improving our knowledge about schizophrenia and the features that can identify this mental illness via speech and EEG. The emotional state is a specific characteristic of schizophrenia that can be identified with speech emotion analysis. The most used features of speech found in the literature review are fundamental frequency (F0), intensity/loudness (I), frequency formants (F1, F2, and F3), Mel-frequency cepstral coefficients (MFCC's), the duration of pauses and sentences (SD), and the duration of silence between words. Combining at least two feature categories achieved high accuracy in the schizophrenia classification. Prosodic and spectral or temporal features achieved the highest accuracy. The work with higher accuracy used the prosodic and spectral features QEVA, SDVV, and SSDL, which were derived from the F0 and spectrogram. The emotional state can be identified with most of the features previously mentioned (F0, I, F1, F2, F3, MFCCs, and SD), linear prediction cepstral coefficients (LPCC), linear spectral features (LSF), and the pause rate. Using the event-related potentials (ERP), the most promissory features found in the literature are mismatch negativity (MMN), P2, P3, P50, N1, and N2. The EEG features with higher accuracy in schizophrenia classification subjects are the nonlinear features, such as Cx, HFD, and Lya.

Abnormal resting-state functional connectivity underlies cognitive and clinical symptoms in patients with schizophrenia

Introduction

The cognitive and psychotic symptoms in patients with schizophrenia (SZ) are thought to result from disrupted brain network connectivity.

Methods

We capitalize on the high spatiotemporal resolution of magnetoencephalography imaging (MEG) to record spontaneous neuronal activity in resting state networks in 21 SZ compared with 21 healthy controls (HC).

Results

We found that SZ showed significant global disrupted functional connectivity in delta-theta (2-8 Hz), alpha (8-12 Hz), and beta (12-30 Hz) frequencies, compared to HC. Disrupted global connectivity in alpha frequencies with bilateral frontal cortices was associated with more severe clinical psychopathology (i.e., positive psychotic symptoms). Specifically, aberrant connectivity in beta frequencies between the left primary auditory cortex and cerebellum, was linked to greater hallucination severity in SZ. Disrupted connectivity in delta-theta frequencies between the medial frontal and left inferior frontal cortex was associated with impaired cognition.

Discussion

The multivariate techniques employed in the present study highlight the importance of applying our source reconstruction techniques which leverage the high spatial localization abilities of MEG for estimating neural source activity using beamforming methods such as SAM (synthetic aperture morphometry) to reconstruct the source of brain activity, together with functional connectivity assessments, assayed with imaginary coherence metrics, to delineate how neurophysiological dysconnectivity in specific oscillatory frequencies between distinct regions underlie the cognitive and psychotic symptoms in SZ. The present findings employ powerful techniques in spatial and time-frequency domains to provide potential neural biomarkers underlying neuronal network dysconnectivity in SZ that will inform the development of innovations in future neuromodulation treatment development.

Approach to impaired corollary discharge in patients with schizophrenia: An analysis of self-induced somatosensory evoked potentials and fields

Background

Difficulty in distinguishing between self-generated actions and those generated by others is a core feature of schizophrenia. This is thought to be underpinned by the failure of corollary discharge. However, few studies have investigated these events using somatosensory evoked potentials (SEPs) and somatosensory evoked magnetic fields (SEFs).

Methods

The study included 15 right-handed patients with schizophrenia and 16 healthy controls. SEP and SEF were elicited by electrical stimuli to the left median nerve at intervals of 1–3 s. In the external condition, stimuli were externally induced by a machine. In the self-condition, stimuli were induced by tapping the participants’ own right index finger. Peak amplitude at C4’ in SEP and root mean square in 10 channels on the right primary somatosensory area in SEF were analyzed.

Results

Although there was a significant main effect of condition at N20m, and a significant main effect of condition and group at P30m, no significant interactions of condition and group were found in either N20m or P30m. The post-hoc Wilcoxon signed-rank test revealed that the peak value of P30m in the external condition was significantly higher than that in the self-condition in the healthy control group only. In addition, there was a significant positive correlation between the peak value of P30m in the self-condition and a positive symptom score.

Conclusion

In the current study, we did not find abnormalities of corollary discharge in primary sensory areas in patients with schizophrenia. Further investigations with more cases may reveal the possibility of corollary discharge disturbance in the primary sensory cortex.

Early evoked brain activity underlies auditory and audiovisual speech recognition deficits in schizophrenia

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Reduced N1 amplitudes reflect speech processing deficits in schizophrenia (SZ).

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Crossmodal N1 amplitude suppression in audiovisual speech is preserved in SZ.

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N1 amplitudes correlate with speech recognition performance in controls but not in SZ.

Objectives

People with Schizophrenia (SZ) show deficits in auditory and audiovisual speech recognition. It is possible that these deficits are related to aberrant early sensory processing, combined with an impaired ability to utilize visual cues to improve speech recognition. In this electroencephalography study we tested this by having SZ and healthy controls (HC) identify different unisensory auditory and bisensory audiovisual syllables at different auditory noise levels.

Methods

SZ (N = 24) and HC (N = 21) identified one of three different syllables (/da/, /ga/, /ta/) at three different noise levels (no, low, high). Half the trials were unisensory auditory and the other half provided additional visual input of moving lips. Task-evoked mediofrontal N1 and P2 brain potentials triggered to the onset of the auditory syllables were derived and related to behavioral performance.

Results

In comparison to HC, SZ showed speech recognition deficits for unisensory and bisensory stimuli. These deficits were primarily found in the no noise condition. Paralleling these observations, reduced N1 amplitudes to unisensory and bisensory stimuli in SZ were found in the no noise condition. In HC the N1 amplitudes were positively related to the speech recognition performance, whereas no such relationships were found in SZ. Moreover, no group differences in multisensory speech recognition benefits and N1 suppression effects for bisensory stimuli were observed.

Conclusion

Our study suggests that reduced N1 amplitudes reflect early auditory and audiovisual speech processing deficits in SZ. The findings that the amplitude effects were confined to salient speech stimuli and the attenuated relationship with behavioral performance in patients compared to HC, indicates a diminished decoding of the auditory speech signals in SZs. Our study also revealed relatively intact multisensory benefits in SZs, which implies that the observed auditory and audiovisual speech recognition deficits were primarily related to aberrant processing of the auditory syllables.

Delusional thinking and action binding in healthy individuals

Action binding is the effect that the perceived time of an action is shifted towards the action related feedback. A much larger action binding effect in schizophrenia compared to normal controls has been shown, which might be due to positive symptoms like delusions. Here we investigated the relationship between delusional thinking and action binding in healthy individuals, predicting a positive correlation between them. The action binding effect was evaluated by comparing the perceived time of a keypress between an operant (keypress triggering a sound) and a baseline condition (keypress alone), with a novel testing method that massively improved the precision of the subjective timing measurement. A positive correlation was found between the tendency of delusional thinking (measured by the 21-item Peters et al. delusions inventory) and action binding across participants after controlling for the effect of testing order between operant and baseline conditions. The results indicate that delusional thinking in particular influences action time perception and support the notion of a continuous distribution of schizotypal traits with normal controls at one end and clinical patients at the other end.

Voluntary control of auditory hallucinations: phenomenology to therapeutic implications

Auditory verbal hallucinations (AVH) have traditionally been thought to be outside the influence of conscious control. However, recent work with voice hearers makes clear that both treatment-seeking and non-treatment-seeking voice hearers may exert varying degrees of control over their voices. Evidence suggests that this ability may be a key factor in determining health status, but little systematic examination of control in AVH has been carried out. This review provides an overview of the research examining control over AVH in both treatment-seeking and non-treatment-seeking populations. We first examine the relationship between control over AVH and health status as well as the psychosocial factors that may influence control and functioning. We then link control to various cognitive constructs that appear to be important for voice hearing. Finally, we reconcile the possibility of control with the field’s current understanding of the proposed cognitive, computational, and neural underpinnings of hallucinations and perception more broadly. Established relationships between control, health status, and functioning suggest that the development of control over AVH could increase functioning and reduce distress. A more detailed understanding of the discrete types of control, their development, and their neural underpinnings is essential for translating this knowledge into new therapeutic approaches.

Real and imagined sensory feedback have comparable effects on action anticipation

The forward model monitors the success of sensory feedback to an action and links it to an efference copy originating in the motor system. The Readiness Potential (RP) of the electroencephalogram has been denoted as a neural signature of the efference copy. An open question is whether imagined sensory feedback works similarly to real sensory feedback. We investigated the RP to audible and imagined sounds in a button-press paradigm and assessed the role of sound complexity (vocal vs. non-vocal sound). Sensory feedback (both audible and imagined) in response to a voluntary action modulated the RP amplitude time-locked to the button press. The RP amplitude increase was larger for actions with expected sensory feedback (audible and imagined) than those without sensory feedback, and associated with N1 suppression for audible sounds. Further, the early RP phase was increased when actions elicited an imagined vocal (self-voice) compared to non-vocal sound. Our results support the notion that sensory feedback is anticipated before voluntary actions. This is the case for both audible and imagined sensory feedback and confirms a role of overt and covert feedback in the forward model.

Disrupted Corollary Discharge in Schizophrenia: Evidence From the Oculomotor System

Corollary discharge (CD) signals are motor-related signals that exert an influence on sensory processing. They allow mobile organisms to predict the sensory consequences of their imminent actions. Among the many functions of CD is to provide a means by which we can distinguish sensory experiences caused by our own actions from those with external causes. In this way, they contribute to a subjective sense of agency. A disruption in the sense of agency is central to many of the clinical symptoms of schizophrenia, and abnormalities in CD signaling have been theorized to underpin particularly those agency-related psychotic symptoms of the illness. Characterizing abnormal CD associated with eye movements in schizophrenia and their resulting influence on visual processing and subsequent action plans may have advantages over other sensory and motor systems. That is because the most robust psychophysiological and neurophysiological data regarding the dynamics and influence of CD as well as the neural circuitry implicated in CD generation and transmission comes from the study of eye movements in humans and nonhuman primates. We review studies of oculomotor CD signaling in the schizophrenia spectrum and possible neurobiological correlates of CD disturbances. We conclude by speculating on the ways in which oculomotor CD dysfunction, specifically, may invoke specific experiences, clinical symptoms, and cognitive impairments. These speculations lay the groundwork for empirical study, and we conclude by outlining potentially fruitful research directions.

Speaking-Induced Suppression of the Auditory Cortex in Humans and Its Relevance to Schizophrenia

Speaking-induced suppression (SIS) is the phenomenon that the sounds one generates by overt speech elicit a smaller neurophysiological response in the auditory cortex than comparable sounds that are externally generated. SIS is a specific example of the more general phenomenon of self-suppression. SIS has been well established in nonhuman animals and is believed to involve the action of corollary discharges. This review summarizes, first, the evidence for SIS in heathy human participants, where it has been most commonly assessed with electroencephalography and/or magnetoencephalography using an experimental paradigm known as "Talk-Listen"; and second, the growing number of Talk-Listen studies that have reported subnormal levels of SIS in patients with schizophrenia. This result is theoretically significant, as it provides a plausible explanation for some of the most distinctive and characteristic symptoms of schizophrenia, namely the first-rank symptoms. In particular, while the failure to suppress the neural consequences of self-generated movements (such as those associated with overt speech) provides a prima facie explanation for delusions of control, the failure to suppress the neural consequences of self-generated inner speech provides a plausible explanation for certain classes of auditory-verbal hallucinations, such as audible thoughts. While the empirical evidence for a relationship between SIS and the first-rank symptoms is currently limited, I predict that future studies with more sensitive experimental designs will confirm its existence. Establishing the existence of a causal, mechanistic relationship would represent a major step forward in our understanding of schizophrenia, which is a necessary precursor to the development of novel treatments.

No Effect of Transcranial Direct Current Stimulation of the Auditory Cortex on Auditory-Evoked Potentials

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique to change cortical excitability. Its effects are shown for cognitive processing, and behavior in the motor and perceptual domains. However, evidence of tDCS effects in the perceptual domain particularly for auditory processing is rare. Therefore, and in the context of disturbances in auditory processing in psychiatric populations, e.g., in patients with auditory verbal hallucinations, we aimed to investigate the potential modulatory effect of tDCS on the excitability of left posterior temporal cortex in detail. We included 24 healthy participants in a crossover design, applying sham and anodal stimulation in two measurement sessions 1 week apart. Electroencephalography (EEG) was recorded while participants listened to tones before, during, and after stimulation. Amplitudes and latencies of P50, N100, and P200 auditory-evoked potentials (AEP) were compared between anodal and sham stimulation, and between time points before, during, and after tDCS. In contrast to previous studies, results demonstrate no significant differences between stimulation types or time points for any of the investigated AEP amplitudes or latencies. Furthermore, a topographical analysis did not show any topographical differences during peak time periods of the investigated AEP for stimulation types and time points besides a habituation effect. Thus, our results suggest that tDCS modulation of excitability of the left posterior temporal cortex, targeting the auditory cortex, does not have any effect on AEP. This is particularly interesting in the context of tDCS as a potential treatment for changed electrophysiological parameters and symptoms of psychiatric diseases, e.g., lower N100 or auditory verbal hallucinations in schizophrenia.

Neurofeedback-Based Enhancement of Single Trial Auditory Evoked Potentials: Feasibility in Healthy Subjects

Previous studies showed a global reduction of the event-related potential component N100 in patients with schizophrenia, a phenomenon that is even more pronounced during auditory verbal hallucinations. This reduction assumingly results from dysfunctional activation of the primary auditory cortex by inner speech, which reduces its responsiveness to external stimuli. With this study, we tested the feasibility of enhancing the responsiveness of the primary auditory cortex to external stimuli with an upregulation of the event-related potential component N100 in healthy control subjects. A total of 15 healthy subjects performed 8 double-sessions of EEG-neurofeedback training over 2 weeks. The results of the used linear mixed effect model showed a significant active learning effect within sessions ( t = 5.99, P < .001) against an unspecific habituation effect that lowered the N100 amplitude over time. Across sessions, a significant increase in the passive condition ( t = 2.42, P = .03), named as carry-over effect, was observed. Given that the carry-over effect is one of the ultimate aims of neurofeedback, it seems reasonable to apply this neurofeedback training protocol to influence the N100 amplitude in patients with schizophrenia. This intervention could provide an alternative treatment option for auditory verbal hallucinations in these patients.

Sensory prediction errors in the continuum of psychosis

Sensory prediction errors are fundamental brain responses that signal a violation of expectation in either the internal or external sensory environment, and are therefore crucial for survival and adaptive behaviour. Patients with schizophrenia show deficits in these internal and external sensory prediction errors, which can be measured using electroencephalography (EEG) components such as N1 and mismatch negativity (MMN), respectively. New evidence suggests that these deficits in sensory prediction errors are more widely distributed on a continuum of psychosis, whereas psychotic experiences exist to varying degrees throughout the general population. In this paper, we review recent findings in sensory prediction errors in the auditory domain across the continuum of psychosis, and discuss these in light of the predictive coding hypothesis.

Neurophysiological evidence of efference copies to inner speech

Efference copies refer to internal duplicates of movement-producing neural signals. Their primary function is to predict, and often suppress, the sensory consequences of willed movements. Efference copies have been almost exclusively investigated in the context of overt movements. The current electrophysiological study employed a novel design to show that inner speech – the silent production of words in one’s mind – is also associated with an efference copy. Participants produced an inner phoneme at a precisely specified time, at which an audible phoneme was concurrently presented. The production of the inner phoneme resulted in electrophysiological suppression, but only if the content of the inner phoneme matched the content of the audible phoneme. These results demonstrate that inner speech – a purely mental action – is associated with an efference copy with detailed auditory properties. These findings suggest that inner speech may ultimately reflect a special type of overt speech.

As you read this text, the chances are you can hear your own inner voice narrating the words. You may hear your inner voice again when silently considering what to have for lunch, or imagining how a phone conversation this afternoon will play out. Estimates suggest that we spend at least a quarter of our lives listening to our own inner speech. But to what extent does the brain distinguish between inner speech and the sounds we produce when we speak out loud?

Listening to a recording of your own voice activates the brain more than hearing yourself speak out loud. This is because when the brain sends instructions to the lips, tongue, and vocal cords telling them to move, it also makes a copy of these instructions. This is known as an efference copy, and it enables regions of the brain that process sounds to predict what they are about to hear. When the actual sounds match those predicted – as when you hear yourself speak out loud – the brain’s sound-processing regions dampen down their responses.

But does the inner speech in our heads also generate an efference copy? To find out, Whitford et al. tracked the brain activity of healthy volunteers as they listened to speech sounds through headphones. While listening to the sounds, the volunteers had to produce either the same speech sound or a different speech sound inside their heads. A specific type of brain activity decreased whenever the inner speech sound matched the external speech sound. This decrease did not occur when the two sounds were different. This suggests that the brain produces an efference copy for inner speech similar to that for external speech.

These findings could ultimately benefit people who suffer from psychotic symptoms, for example as part of schizophrenia. Symptoms such as hearing voices are thought to reflect problems with producing and interpreting inner speech. The technique that Whitford et al. have developed will enable us to test this long-held but hitherto untestable idea. The results should increase our understanding of these symptoms and may eventually lead to new treatments.

Neural responses to feedback information produced by self-generated or other-generated decision-making and their impairment in schizophrenia

Several studies of self-monitoring dysfunction in schizophrenia have focused on the sense of agency to motor action using behavioral and psychophysiological techniques. So far, no study has ever tried to investigate whether the sense of agency or causal attribution for external events produced by self-generated decision-making is abnormal in schizophrenia. The purpose of this study was to investigate neural responses to feedback information produced by self-generated or other-generated decision-making in a multiplayer gambling task using even-related potentials and electroencephalogram synchronization. We found that the late positive component and theta/alpha synchronization were increased in response to feedback information in the self-decision condition in normal controls, but that these responses were significantly decreased in patients with schizophrenia. These neural activities thus reflect the self-reference effect that affects the cognitive appraisal of external events following decision-making and their impairment in schizophrenia.

Transsaccadic Perception Deficits in Schizophrenia Reflect the Improper Internal Monitoring of Eye Movement Rather Than Abnormal Sensory Processing

BACKGROUND

Symptoms of psychosis in schizophrenia reflect disturbances in sense of agency-difficulty distinguishing internally from externally generated sensory and perceptual experiences. One theory attributes these anomalies to a disruption in corollary discharge (CD), an internal copy of generated motor commands used to distinguish self-movement-generated sensations from externally generated stimulation.

METHODS

We used a transsaccadic shift detection paradigm to examine possible deficits in CD and sense of agency based on the ability to perceive visual changes in 31 schizophrenia patients (SZPs) and 31 healthy control subjects. We derived perceptual measures based on manual responses indicating the transsaccadic target shift direction. We also developed a distance-from-unity-line measure to quantify use of CD versus purely sensory (visual) information in evaluating visual changes in the environment after an eye movement.

RESULTS

SZPs had higher perceptual thresholds in detecting shift of target location than healthy control subjects, regardless of movement direction or amplitude. Despite producing similar hypometric saccades, healthy control subjects overestimated target location, whereas SZPs relied more on the experienced visual error and consequently underestimated the target position. We show that in SZPs the postsaccadic judgment of the initial target location was largely aligned with the measure based only on visual error, suggesting a deficit in the use of CD. This CD deficit also correlated with positive schizophrenia symptoms and disturbances in sense of agency.

CONCLUSIONS

These results provide a novel approach in quantifying abnormal use of CD in SZPs and provide a framework to distinguish deficits in sensory processing versus defects in the internal CD-based monitoring of movement.

Oculomotor Prediction: A Window into the Psychotic Mind

Psychosis - an impaired contact with reality - is a hallmark of schizophrenia. Many psychotic symptoms are associated with disruptions in agency - the sense that 'I' cause my actions. A failure to predict sensory consequences of one's own actions may underlie agency disturbances. Such predictions rely on corollary discharge (CD) signals, 'copies' of movement commands sent to sensory regions prior to action execution. Here, we make a case that the oculomotor system is a promising model for understanding CD in psychosis, building on advances in our understanding of the behavioral and neurophysiological correlates of CD associated with eye movements. In this opinion article, we provide an overview of recent evidence for disturbed oculomotor CD in schizophrenia, potentially linking bizarre and disturbing psychotic experiences with basic physiological processes.

Amygdalar Auditory Neurons Contribute to Self-Other Distinction during Ultrasonic Social Vocalization in Rats

Although, clinical studies reported hyperactivation of the auditory system and amygdala in patients with auditory hallucinations (hearing others' but not one's own voice, independent of any external stimulus), neural mechanisms of self/other attribution is not well understood. We recorded neuronal responses in the dorsal amygdala including the lateral amygdaloid nucleus to ultrasonic vocalization (USVs) emitted by subjects and conspecifics during free social interaction in 16 adult male rats. The animals emitting the USVs were identified by EMG recordings. One-quarter of the amygdalar neurons (15/60) responded to 50 kHz calls by the subject and/or conspecifics. Among the responsive neurons, most neurons (Type-Other neurons; 73%, 11/15) responded only to calls by conspecifics but not subjects. Two Type-Self neurons (13%, 2/15) responded to calls by the subject but not those by conspecifics, although their response selectivity to subjects vs. conspecifics was lower than that of Type-Other neurons. The remaining two neurons (13%) responded to calls by both the subject and conspecifics. Furthermore, population coding of the amygdalar neurons represented distinction of subject vs. conspecific calls. The present results provide the first neurophysiological evidence that the amygdala discriminately represents affective social calls by subject and conspecifics. These findings suggest that the amygdala is an important brain region for self/other attribution. Furthermore, pathological activation of the amygdala, where Type-Other neurons predominate, could induce external misattribution of percepts of vocalization.

A Cognitive Neuroscience View of Voice-Processing Abnormalities in Schizophrenia: A Window into Auditory Verbal Hallucinations?

Auditory verbal hallucinations (AVH) are a core symptom of schizophrenia. Like "real" voices, AVH carry a rich amount of linguistic and paralinguistic cues that convey not only speech, but also affect and identity, information. Disturbed processing of voice identity, affective, and speech information has been reported in patients with schizophrenia. More recent evidence has suggested a link between voice-processing abnormalities and specific clinical symptoms of schizophrenia, especially AVH. It is still not well understood, however, to what extent these dimensions are impaired and how abnormalities in these processes might contribute to AVH. In this review, we consider behavioral, neuroimaging, and electrophysiological data to investigate the speech, identity, and affective dimensions of voice processing in schizophrenia, and we discuss how abnormalities in these processes might help to elucidate the mechanisms underlying specific phenomenological features of AVH. Schizophrenia patients exhibit behavioral and neural disturbances in the three dimensions of voice processing. Evidence suggesting a role of dysfunctional voice processing in AVH seems to be stronger for the identity and speech dimensions than for the affective domain.

The effect of auditory verbal imagery on signal detection in hallucination-prone individuals

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Investigated relation between hallucinations, mental imagery and signal detection.

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Individuals prone to hallucinations showed a lower SDT response bias with imagery.

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Finding held for both instructed and self-reported use of auditory verbal imagery.

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Atypical auditory imagery may lead to the generation of auditory hallucinations.

Cognitive models have suggested that auditory hallucinations occur when internal mental events, such as inner speech or auditory verbal imagery (AVI), are misattributed to an external source. This has been supported by numerous studies indicating that individuals who experience hallucinations tend to perform in a biased manner on tasks that require them to distinguish self-generated from non-self-generated perceptions. However, these tasks have typically been of limited relevance to inner speech models of hallucinations, because they have not manipulated the AVI that participants used during the task. Here, a new paradigm was employed to investigate the interaction between imagery and perception, in which a healthy, non-clinical sample of participants were instructed to use AVI whilst completing an auditory signal detection task. It was hypothesized that AVI-usage would cause participants to perform in a biased manner, therefore falsely detecting more voices in bursts of noise. In Experiment 1, when cued to generate AVI, highly hallucination-prone participants showed a lower response bias than when performing a standard signal detection task, being more willing to report the presence of a voice in the noise. Participants not prone to hallucinations performed no differently between the two conditions. In Experiment 2, participants were not specifically instructed to use AVI, but retrospectively reported how often they engaged in AVI during the task. Highly hallucination-prone participants who retrospectively reported using imagery showed a lower response bias than did participants with lower proneness who also reported using AVI. Results are discussed in relation to prominent inner speech models of hallucinations.

Disrupted Saccadic Corollary Discharge in Schizophrenia

Disruptions in corollary discharge (CD), motor signals that send information to sensory areas and allow for prediction of sensory states, are argued to underlie the perceived loss of agency in schizophrenia. Behavioral and neurophysiological evidence for CD in primates comes largely from the saccadic double-step task, which requires participants to make two visually triggered saccadic eye movements in brief succession. Healthy individuals use CD to anticipate the change in eye position resulting from the first saccade when preparing the second saccade. In the current study with human participants, schizophrenia patients and healthy controls of both sexes performed a modified double-step task. Most trials required a saccade to a single visual target (T1). On a subset of trials, a second target (T2) was flashed shortly following T1. Subjects were instructed to look directly at T2. Healthy individuals also use CD to make rapid, corrective responses following erroneous saccades to T1. To assess CD in schizophrenia, we examined the following on error trials: (1) frequency and latency of corrective saccades, and (2) mislocalization of the corrective (second) saccade in the direction predicted by a failure to use CD to account for the first eye movement. Consistent with disrupted CD, patients made fewer and slower error corrections. Importantly, the corrective saccade vector angle was biased in a manner consistent with disrupted CD. These results provide novel and clear evidence for dysfunctional CD in the oculomotor system in patients with schizophrenia. Based on neurophysiology work, these disturbances might have their basis in medial thalamus dysfunction.

SIGNIFICANCE STATEMENT

According to the World Health Organization, acute schizophrenia carries more disability weight than any other disease, but its etiology remains unknown. One promising theory of schizophrenia highlights alterations in a sense of self, in which self-generated thoughts or actions are attributed externally. Disruptions in corollary discharge (CD), motor signals sent to sensory areas that allow for the prediction of impending sensations, are proposed to underlie these symptoms. Direct physiological evidence, however, is limited. In nonhuman primates, inactivation of mediodorsal thalamic neurons disrupts CD associated with eye movements. Using the same task, we show similar impairments in schizophrenia patients, consistent with disrupted CD. These findings allow us to link clinical phenomenology to primate neurophysiology and interpret findings within a biological framework.

Auditory hallucinations: A review of the ERC “VOICE” project

In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the “VOICE” ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the “voices” having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app.

A new comparator account of auditory verbal hallucinations: how motor prediction can plausibly contribute to the sense of agency for inner speech

The comparator account holds that processes of motor prediction contribute to the sense of agency by attenuating incoming sensory information and that disruptions to this process contribute to misattributions of agency in schizophrenia. Over the last 25 years this simple and powerful model has gained widespread support not only as it relates to bodily actions but also as an account of misattributions of agency for inner speech, potentially explaining the etiology of auditory verbal hallucination (AVH). In this paper we provide a detailed analysis of the traditional comparator account for inner speech, pointing out serious problems with the specification of inner speech on which it is based and highlighting inconsistencies in the interpretation of the electrophysiological evidence commonly cited in its favor. In light of these analyses we propose a new comparator account of misattributed inner speech. The new account follows leading models of motor imagery in proposing that inner speech is not attenuated by motor prediction, but rather derived directly from it. We describe how failures of motor prediction would therefore directly affect the phenomenology of inner speech and trigger a mismatch in the comparison between motor prediction and motor intention, contributing to abnormal feelings of agency. We argue that the new account fits with the emerging phenomenological evidence that AVHs are both distinct from ordinary inner speech and heterogeneous. Finally, we explore the possibility that the new comparator account may extend to explain disruptions across a range of imagistic modalities, and outline avenues for future research.

A synthesis of evidence on inhibitory control and auditory hallucinations based on the Research Domain Criteria (RDoC) framework

The National Institute of Mental Health initiative called the Research Domain Criteria (RDoC) project aims to provide a new approach to understanding mental illness grounded in the fundamental domains of human behavior and psychological functioning. To this end the RDoC framework encourages researchers and clinicians to think outside the [diagnostic] box, by studying symptoms, behaviors or biomarkers that cut across traditional mental illness categories. In this article we examine and discuss how the RDoC framework can improve our understanding of psychopathology by zeroing in on hallucinations- now widely recognized as a symptom that occurs in a range of clinical and non-clinical groups. We focus on a single domain of functioning-namely cognitive [inhibitory] control-and assimilate key findings structured around the basic RDoC "units of analysis," which span the range from observable behavior to molecular genetics. Our synthesis and critique of the literature provides a deeper understanding of the mechanisms involved in the emergence of auditory hallucinations, linked to the individual dynamics of inhibitory development before and after puberty; favors separate developmental trajectories for clinical and non-clinical hallucinations; yields new insights into co-occurring emotional and behavioral problems; and suggests some novel avenues for treatment.

Physiological correlates of positive symptoms in schizophrenia

Patients with schizophrenia have been hypothesized to have a functional impairment in filtering irrelevant sensory information, which may result in positive symptoms such as hallucinations or delusions. Many evidences suggest that abnormalities in the event-related brain potentials (ERPs), resting state electroencephalography (EEG) and synchronized oscillatory activity of neurons may reflect core pathophysiological mechanisms of schizophrenia. Abnormalities in amplitude and latency of the ERPs reflecting aberrations in gating and difficulties in the detection of changes in auditory stimuli, as well as defects in stimuli evaluation and integration of information are common in patients with schizophrenia. This chapter highlights the findings of electrophysiological studies in schizophrenia dealing with early sensory perception and attention, automatic sensory detection of stimuli changes and cognitive evaluation and integration of information, relevant to the pathophysiological mechanisms underpinning hallucinations and delusions. Results of electrophysiological studies investigating the neural correlates of positive symptoms suggest aberrant intrinsic organization of functional brain networks.

Neurophysiological evidence of corollary discharge function during vocalization in psychotic patients and their nonpsychotic first-degree relatives

Predictions about sensations resulting from motor acts are instantiated through neural mechanisms such as the corollary discharge. With each action, the corollary discharge provides an unconscious comparison between predicted and actual sensations resulting from the action; closer matches result in greater suppression of sensation. This mechanism is disrupted in schizophrenia (SZ) and may contribute to, or reflect a failure to, distinguish self- from externally generated experiences, a hallmark of psychosis. We asked whether disruption is specific to SZ or is seen in other psychotic illnesses and in first-degree relatives of psychotic patients. Corollary discharge function was assessed in SZ patients (n = 30), schizoaffective (SA) patients (n = 19), bipolar patients with a history of psychosis (BPP; n = 39), nonpsychotic relatives of SZ (n = 30), SA (n = 23), and BPP (n = 50) patients, and healthy controls (n = 43). The N1 component of the event-related potential, reflecting auditory cortical responses to sounds, was elicited by speech sound onset as subjects talked and later when they listened to a recording of those sounds. N1 was suppressed during talking compared to N1 during listening, consistent with the suppressive action of the corollary discharge mechanism. Suppression was significantly reduced in SZ and BPP patients, with a similar trend in the smaller SA group. Patient groups did not differ, and unaffected relatives did not differ from controls or probands. The failure to monitor sensations resulting from self-generated actions, implicating corollary discharge dysfunction, may be a common feature across affective and nonaffective psychosis. Data from unaffected family members do not indicate that this is a marker of psychosis risk.

Auditory cortex responsiveness during talking and listening: early illness schizophrenia and patients at clinical high-risk for psychosis

OBJECTIVE

The corollary discharge mechanism is theorized to dampen sensations resulting from our own actions and distinguish them from environmental events. Deficits in this mechanism in schizophrenia may contribute to misperceptions of self-generated sensations as originating from external stimuli. We previously found attenuated speech-related suppression of auditory cortex in chronic patients, consistent with such deficits. Whether this abnormality precedes psychosis onset, emerges early in the illness, and/or progressively worsens with illness chronicity, is unknown.

METHODS

Event-related potentials (ERPs) were recorded from schizophrenia patients (SZ; n = 75) and age-matched healthy controls (HC; n = 77). A subsample of early illness schizophrenia patients (ESZ; n = 39) was compared with patients at clinical high-risk for psychosis (CHR; n = 35) and to a subgroup of age-matched HC (n = 36) during a Talk-Listen paradigm. The N1 ERP component was elicited by vocalizations as subjects talked (Talk) and heard them played back (Listen).

RESULTS

As shown previously, SZ showed attenuated speech-related N1 suppression relative to HC. This was also observed in ESZ. N1 suppression values in CHR were intermediate to HC and ESZ and not statistically distinguishable from either comparison group. Age-corrected N1 Talk-Listen difference z scores were not correlated with illness duration in the full SZ sample.

CONCLUSIONS

Putative dysfunction of the corollary discharge mechanism during speech is evident early in the illness and is stable over its course. The intermediate effects in CHR patients may reflect the heterogeneity of this group, requiring longitudinal follow-up data to address if speech-related N1 suppression abnormalities are a risk marker for conversion to psychosis.

Neural correlates of the lombard effect in primate auditory cortex

Speaking is a sensory-motor process that involves constant self-monitoring to ensure accurate vocal production. Self-monitoring of vocal feedback allows rapid adjustment to correct perceived differences between intended and produced vocalizations. One important behavior in vocal feedback control is a compensatory increase in vocal intensity in response to noise masking during vocal production, commonly referred to as the Lombard effect. This behavior requires mechanisms for continuously monitoring auditory feedback during speaking. However, the underlying neural mechanisms are poorly understood. Here we show that when marmoset monkeys vocalize in the presence of masking noise that disrupts vocal feedback, the compensatory increase in vocal intensity is accompanied by a shift in auditory cortex activity toward neural response patterns seen during vocalizations under normal feedback condition. Furthermore, we show that neural activity in auditory cortex during a vocalization phrase predicts vocal intensity compensation in subsequent phrases. These observations demonstrate that the auditory cortex participates in self-monitoring during the Lombard effect, and may play a role in the compensation of noise masking during feedback-mediated vocal control.

A neurophysiological deficit in early visual processing in schizophrenia patients with auditory hallucinations

Existing 67-channel event-related potentials, obtained during recognition and working memory paradigms with words or faces, were used to examine early visual processing in schizophrenia patients prone to auditory hallucinations (AH, n = 26) or not (NH, n = 49) and healthy controls (HC, n = 46). Current source density (CSD) transforms revealed distinct, strongly left- (words) or right-lateralized (faces; N170) inferior-temporal N1 sinks (150 ms) in each group. N1 was quantified by temporal PCA of peak-adjusted CSDs. For words and faces in both paradigms, N1 was substantially reduced in AH compared with NH and HC, who did not differ from each other. The difference in N1 between AH and NH was not due to overall symptom severity or performance accuracy, with both groups showing comparable memory deficits. Our findings extend prior reports of reduced auditory N1 in AH, suggesting a broader early perceptual integration deficit that is not limited to the auditory modality.

Inner speech during silent reading reflects the reader's regional accent

While reading silently, we often have the subjective experience of inner speech. However, there is currently little evidence regarding whether this inner voice resembles our own voice while we are speaking out loud. To investigate this issue, we compared reading behaviour of Northern and Southern English participants who have differing pronunciations for words like ‘glass’, in which the vowel duration is short in a Northern accent and long in a Southern accent. Participants' eye movements were monitored while they silently read limericks in which the end words of the first two lines (e.g., glass/class) would be pronounced differently by Northern and Southern participants. The final word of the limerick (e.g., mass/sparse) then either did or did not rhyme, depending on the reader's accent. Results showed disruption to eye movement behaviour when the final word did not rhyme, determined by the reader's accent, suggesting that inner speech resembles our own voice.

Anticipating the future: automatic prediction failures in schizophrenia

People with schizophrenia often misperceive sensations and misinterpret experiences, perhaps contributing to psychotic symptoms. These misperceptions and misinterpretations might result from an inability to make valid predictions about expected sensations and experiences. Healthy normal people take advantage of neural mechanisms that allow them to make predictions unconsciously, facilitating processing of expected sensations and distinguishing the expected from the unexpected. In this paper, we focus on two types of automatic, unconscious mechanisms that allow us to predict our perceptions. The first involves predictions made via innate mechanisms basic to all species in the animal kingdom - the efference copy and corollary discharge mechanisms. They accompany our voluntary movements and allow us to suppress sensations resulting from our actions. We study this during talking, and show that auditory cortical response to the speech sounds during talking is reduced compared to when they are played back. This suppression is reduced in schizophrenia, suggesting a failure to predict the sensations resulting from talking. The second mechanism involves implicitly learning what to expect from the current context of events. We study this by observing the brain's response to an unexpected repetition of an event, when a change would have been predicted. That patients have a reduced response suggests they failed to predict that it was time for a change. Both types of predictions should happen automatically and effortlessly, allowing for economic processing of expected events and orientation to unexpected ones. These prediction failures characterize the diagnosis of schizophrenia rather than reflecting specific symptoms.

The neurophysiology of auditory hallucinations - a historical and contemporary review

Electroencephalography and magnetoencephalography are two techniques that distinguish themselves from other neuroimaging methodologies through their ability to directly measure brain-related activity and their high temporal resolution. A large body of research has applied these techniques to study auditory hallucinations. Across a variety of approaches, the left superior temporal cortex is consistently reported to be involved in this symptom. Moreover, there is increasing evidence that a failure in corollary discharge, i.e., a neural signal originating in frontal speech areas that indicates to sensory areas that forthcoming thought is self-generated, may underlie the experience of auditory hallucinations.

Mental imagery of speech and movement implicates the dynamics of internal forward models

The classical concept of efference copies in the context of internal forward models has stimulated productive research in cognitive science and neuroscience. There are compelling reasons to argue for such a mechanism, but finding direct evidence in the human brain remains difficult. Here we investigate the dynamics of internal forward models from an unconventional angle: mental imagery, assessed while recording high temporal resolution neuronal activity using magnetoencephalography. We compare two overt and covert tasks; our covert, mental imagery tasks are unconfounded by overt input/output demands – but in turn necessitate the development of appropriate multi-dimensional topographic analyses. Finger tapping (studies 1 and 2) and speech experiments (studies 3–5) provide temporally constrained results that implicate the estimation of an efference copy. We suggest that one internal forward model over parietal cortex subserves the kinesthetic feeling in motor imagery. Secondly, observed auditory neural activity ~170 ms after motor estimation in speech experiments (studies 3–5) demonstrates the anticipated auditory consequences of planned motor commands in a second internal forward model in imagery of speech production. Our results provide neurophysiological evidence from the human brain in favor of internal forward models deploying efference copies in somatosensory and auditory cortex, in finger tapping and speech production tasks, respectively, and also suggest the dynamics and sequential updating structure of internal forward models.

Superior size-weight illusion performance in patients with schizophrenia: evidence for deficits in forward models

When non-psychiatric individuals compare the weights of two similar objects of identical mass, but of different sizes, the smaller object is often perceived as substantially heavier. This size-weight illusion (SWI) is thought to be generated by a violation of the common expectation that the large object will be heavier, possibly via a mismatch between an efference copy of the movement and the actual sensory feedback received. As previous research suggests that patients with schizophrenia have deficits in forward model/efference copy mechanisms, we hypothesized that schizophrenic patients would show a reduced SWI. The current study compared the strength of the SWI in schizophrenic patients to matched non-psychiatric participants; weight discrimination for same-sized objects was also assessed. We found a reduced SWI for schizophrenic patients, which resulted in better (more veridical) weight discrimination performance on illusion trials compared to non-psychiatric individuals. This difference in the strength of the SWI persisted when groups were matched for weight discrimination performance. The current findings are consistent with a dysfunctional forward model mechanism in this population. Future studies to elucidate the locus of this impairment using variations on the current study are also proposed.

Assessing corollary discharge in humans using noninvasive neurophysiological methods

In this paper, we present a vocal production protocol for studying the neurophysiological action of the corollary discharge, a mechanism that allows animals to ignore sensations resulting from their own actions, and tag them as 'self'. Electroencephalograms are recorded while subjects say 'ah' about 100 times with minimal throat, jaw and tongue movements (Talk condition). This sequence of sounds is recorded and played back during the Listen condition. Event-related potentials are synchronized to the onset of speech sounds during the Talk and Listen conditions. Neural responses from the auditory cortex to the spoken sound as it is being spoken during the Talk condition are compared with neural responses to the same sounds when played back during the Listen condition. The successful action of the corollary discharge is seen when the response of the auditory cortex is suppressed during the Talk compared with the Listen condition. The protocol takes about 5 min to complete.

Functional magnetic resonance imaging of inner speech in schizophrenia

BACKGROUND

Auditory verbal hallucinations in schizophrenia have been linked to defective monitoring of one's own verbal thoughts. Previous studies have shown that patients with auditory verbal hallucinations show attenuated activation of brain regions involved with auditory processing during the monitoring of inner speech. However, there are no functional magnetic resonance imaging studies explicitly comparing the perception of external speech with internal speech in the same patients with schizophrenia. The present study investigated the functional neuroanatomy of inner and external speech in both patients with schizophrenia and healthy control subjects.

METHODS

Fifteen patients with schizophrenia and 12 healthy control subjects were studied using functional magnetic resonance imaging while listening to sentences or imagining sentences.

RESULTS

Significant interactions between group (control subjects vs. patients) and task (listening vs. inner speech) were seen for the left superior temporal gyrus, as well as regions within the cingulate gyrus.

CONCLUSIONS

Attenuated deactivation of the left superior temporal gyrus in schizophrenia patients during the processing of inner speech may reflect deficits in the forward models subserving self-monitoring.

Corollary discharge dysfunction in schizophrenia: evidence for an elemental deficit

Evidence is accumulating that schizophrenia is characterized by dysfunction of efference copy/corollary discharge mechanisms that normally allow us to unconsciously recognize and disregard sensations resulting from our own actions. This dysfunction may give rise to subtle but pervasive sensory/perceptual aberrations in schizophrenic patients, altering their experience of their own overt and covert actions, as well as their interactions with the environment. It may also contribute to symptoms such as hallucinations and delusions, and may disrupt the motivation to engage with people and in activities. We developed neurophysiological paradigms to study motor-sensory feed-forward processes, or efference copy/corollary discharge mechanisms, in the speech-auditory system, and showed these processes to be deficient in chronic schizophrenia. Specifically, we observed neural responses during talking that made evident the suppressive consequences of a successful corollary discharge mechanism. We also observed synchronous neural activity preceding talking that we believe reflects the efference copy in action. Recently, we extended this neurophysiological research to the somatosensory system, again finding evidence of deficient motor-sensory feed-forward processes in schizophrenia. If dysfunction of this elemental mechanism is reliable, valid, and not the result of antipsychotic medications, it might represent a major new class of electrophysiological measures sensitive to a fundamental and ubiquitous pathophysiological process in schizophrenia.

Left hemisphere lateralisation of auditory hallucinations in schizophrenia: a dichotic listening study

INTRODUCTION

We propose that auditory hallucinations are internally generated speech misrepresentations that are lateralised to the left temporal lobe. If hallucinations are misrepresentations involving the speech perception area of the left temporal lobe, then hallucinating patients should have problems identifying a simultaneously presented external speech sound, especially when the sound is lateralised to the left hemisphere. Lateralisation of speech perception can be experimentally studied with the dichotic listening task with consonant-vowel syllables. We predicted a negative relation between frequency of auditory hallucinations and performance on the dichotic listening task.

METHOD

We studied 87 right-handed patients with schizophrenia. Hallucination scores were taken from the BPRS symptom scale. Right and left ear scores in the dichotic listening task were recorded. A right ear advantage is expected in healthy individuals, indicating left temporal lobe processing superiority. The patients were compared with 36 right-handed healthy reference subjects.

RESULTS

A gradual decrease in the ability to process and report the right ear stimulus with increasing frequency of hallucinations was seen in the schizophrenia patients. No such relationship was found for processing and reporting of the left ear stimulus. There were no significant correlations with negative symptoms. Thus, the results were not the consequence of illness severity. There was however a significant correlation with unusual thought content symptom, pointing to a relationship also between delusions and auditory hallucinations.

CONCLUSION

The results support that auditory hallucinations may be internally generated speech misrepresentations, originating in the left temporal lobe.

A neurocognitive approach to the study of private speech

The paper presents the current state of the art of research identifying the neurophysiological and neuroanatomical substrates of private speech, both in typical and clinical (or atypical) populations. First, it briefly describes the evolution of private speech research, which goes from classic traditions as the naturalistic and referential paradigms to the neurocognitive approach. An overview of the neurophysiological (e.g., event-related potentials or ERPs) and neuroimaging techniques (e.g., functional magnetic resonance imaging or fMRI) is also presented. The next three sections review empirical works about the neurocognitive basis of private speech, across three groups of techniques: ERPs; fMRI/MRI; and other neuroimaging techniques (positron emission tomography [PET], magnetoencephalogram [MEG], and repetitive transcranial magnetic stimulation [rTMS]). Such neurocognitive research analyzes the neural activity of individuals during a variety of task settings, including spontaneous and instructed overt and inner private speech use, subvocal verbalizations, and silent and overt reading. The fifth section focuses on electrophysiological and neuroimaging studies of private speech in atypical populations, for example: schizophrenia, pure alexia, hearing impairment, blindness, social phobia, alexithymia, Parkinson, and multiple sclerosis. The neurocognitive study of the various forms of private speech appears to be very promising in the understanding of these pathologies. Lastly, the advances and new challenges in the field are discussed.

Competition for neuronal resources: how hallucinations make themselves heard

BACKGROUND

Hallucinations are perceptions in the absence of a corresponding external sensory stimulus. However, during auditory verbal hallucinations, activation of the primary auditory cortex has been described.

AIMS

The objective of this study was to investigate whether this activation of the auditory cortex contributes essentially to the character of hallucinations and attributes them to alien sources, or whether the auditory activation is a sign of increased general auditory attention to external sounds.

METHOD

The responsiveness of the auditory cortex was investigated by auditory evoked potentials (N100) during the simultaneous occurrence of hallucinations and external stimuli. Evoked potentials were computed separately for periods with and without hallucinations; N100 power, topography and brain electrical sources were analysed.

RESULTS

Hallucinations lowered the N100 amplitudes and changed the topography, presumably due to a reduced left temporal responsivity.

CONCLUSIONS

This finding indicates competition between auditory stimuli and hallucinations for physiological resources in the primary auditory cortex. The abnormal activation of the primary auditory cortex may thus be a constituent of auditory hallucinations.